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Randomized Controlled Trial
. 2023 Oct;32(10):1111-1119.
doi: 10.1089/jwh.2022.0306. Epub 2023 Aug 16.

Understanding Perinatal Depression Care Gaps by Examining Care Access and Barriers in Perinatal Individuals With and Without Psychiatric History

Eileen McNicholas  1   2 , Esther Boama-Nyarko  1   2 , Clevanne Julce  1   2 , Anthony P Nunes  1   2 , Julie Flahive  1   2 , Nancy Byatt  1   3   2 , Tiffany A Moore Simas  1   3   2
Affiliations
Randomized Controlled Trial

Understanding Perinatal Depression Care Gaps by Examining Care Access and Barriers in Perinatal Individuals With and Without Psychiatric History

Eileen McNicholas et al. J Womens Health (Larchmt). 2023 Oct.

Abstract

Background: Depression affects one in seven perinatal individuals and remains underdiagnosed and undertreated. Individuals with a psychiatric history are at an even greater risk of perinatal depression, but it is unclear how their experiences with the depression care pathway may differ from individuals without a psychiatric history. Methods: We conducted a secondary analysis evaluating care access and barriers to care in perinatal individuals who screened positive for depression using the Edinburgh Postnatal Depression Scale (N = 280). Data were analyzed from the PRogram in Support of Moms (PRISM) study, a cluster randomized controlled trial of two interventions for perinatal depression. Results: Individuals with no prepregnancy psychiatric history (N = 113), compared with those with a history (N = 167), were less likely to be screened for perinatal depression, and less likely to be offered a therapy referral, although equally likely to attend if referred. When examining how these differences affected outcomes, those without a psychiatric history had 46% lower odds of attending therapy (95% confidence interval [CI]: 0.19-1.55), 79% lower odds of taking medication (95% CI: 0.08-0.54), and 80% lower odds of receiving any depression care (95% CI: 0.08-0.47). Barriers were similar across groups, except for concerns regarding available treatments and beliefs about self-resolution of symptoms, which were more prevalent in individuals without a psychiatric history. Conclusions: Perinatal individuals without a prepregnancy psychiatric history were less likely to be screened, referred, and treated for depression. Differences in screening and referrals resulted in missed opportunities for care, reinforcing the urgent need for universal mental health screening and psychoeducation during the perinatal period. Clinical Trial Registration No.: NCT02935504.

Keywords: barriers; care access; perinatal depression; psychiatric history.

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Conflict of interest statement

T.A.M.S. is lead obstetric engagement liaison as a consultant for the MCPAP for Moms and as such has received a stipend from the Massachusetts Department of Mental Health via Beacon Health Options. T.A.M.S. is medical director of Lifeline for Moms at UMass Chan Medical School and Multiple Principle Investigator (MPI) of the Lifeline for Moms National Network of Perinatal Psychiatry Access Programs which is supported by the Perigee fund. In addition, she is co-PI, MPI or co-investigator (co-I) on other federally funded grants focused on intervention or resource development and evaluation related to perinatal mental health. T.A.M.S. is co-chair of the ACOG's Maternal Mental Health Expert Work Group, a member of ACOG's Clinical Practice Guidelines—Obstetrics Committee, a member of the Alliance on Innovation in Maternal Health's (AIM) perinatal mental health conditions patient safety bundle development work group and lead faculty for the Institute of Healthcare Innovation's (IHI) associated change package work group.

N.B. has received salary and/or funding support from Massachusetts Department of Mental Health via the MCPAP for Moms. She is also the Medical Director of Research and Evaluation for MCPAP for Moms and the Executive Director of the Lifeline for Families Center and Lifeline for Moms Program at UMass Chan Medical School. She is the Corresponding Principal Investigator (PI) of the Lifeline for Moms National Network of Perinatal Psychiatry Access Programs, and PI, MPI, or co-I on several extramurally funded grants focused on intervention or resource development and evaluation related to perinatal mental health. She has received honoraria from Global Learning Collaborative. She has also served as a consultant for The Kinetix Group, VentureWell, and JBS International. All other authors have no conflicts of interest to disclose.

Figures

FIG. 1.
FIG. 1.
Sankey diagram of the perinatal depression care pathway as experienced by those with versus without psychiatric history. Pathway includes screening, referral to psychotherapy, and attendance of psychotherapy. Differences were statistically significant in rates of screening and therapy referral; there was no significant difference in therapy attendance.
FIG. 2.
FIG. 2.
Percent of perinatal individuals with versus without psychiatric history reporting each of the top 10 most reported barriers to perinatal depression care. *Statistically significant difference in rates between groups.
See this image and copyright information in PMC

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